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Kheirbek N, Delporte V, El Hajj H, Martin C, Delplanque S, Kerbage Y, Rubod C, Cosson M, Giraudet G. Comparing vNOTES Hysterectomy with Laparoscopic Hysterectomy for Large Uteri. J Minim Invasive Gynecol 2023; 30:877-883. [PMID: 37422053 DOI: 10.1016/j.jmig.2023.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
STUDY OBJECTIVE Our study aimed to compare conventional laparoscopic hysterectomies (LHs) with vaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomies performed for patients with large uteri (weight >280 g) at our institution, which underwent a change in practice from conventional LH to vNOTES for large uteri. DESIGN Retrospective cohort. SETTING French tertiary university hospital. PATIENTS Two cohorts: the last 54 patients who underwent vNOTES hysterectomy and the last 52 patients who underwent conventional LH for large uteri. INTERVENTION Baseline characteristics and surgical outcomes were assessed, including uterine weight, mode of delivery for previous pregnancies, history of abdominal surgery, indication for hysterectomy, associated procedures, operative time (OT), complications, volume of intraoperative bleeding, and length of postoperative hospital stay. MEASUREMENTS AND MAIN RESULTS Both groups were comparable, with a mean uterine weight of 586.4 ± 289.2 g in the laparoscopy group compared with 686.7 ± 374.6 g in the vNOTES group. There was a significant decrease in the OT in the vNOTES group with a median of 99 minutes (66.5-138.5 minutes) compared with 171 minutes (131-208 minutes) in the laparoscopy group, p <.001. The length of hospital stay was also decreased in the vNOTES group with a median of 0.5 nights compared with 2 nights in the laparoscopy group, p <.001. More patients were managed in an ambulatory setting in the vNOTES group (50% vs 3.7%, p <.001). Our study did not find any significant difference in terms of bleeding or the number of conversions to another surgical approach. The frequency of intraoperative and postoperative complications was very low. CONCLUSION Compared with the laparoscopic approach, vNOTES hysterectomy for large uteri (>280 g) is associated with decreased OT, a shorter hospital stay, and increased performance in the ambulatory setting.
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Affiliation(s)
- Nour Kheirbek
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France.
| | - Victoire Delporte
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Houssein El Hajj
- Department of Gynecologic Oncology and Senology, Curie Institute, Saint Cloud, France (Drs. El Hajj)
| | - Claire Martin
- Department of Biostatistics (Dr. Martin), Lille University and Lille University Hospital, ULR 2694 - METRICS: evaluation of health technologies and medical practices, Lille, France
| | - Sophie Delplanque
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
| | - Yohan Kerbage
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Chrystèle Rubod
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Michel Cosson
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France; University of Lille, Henri Warembourg, Lille, France (Drs. Kerbage, Rubod, and Cosson)
| | - Geraldine Giraudet
- Department of Gynecologic Surgery (Drs. Kheirbek, Delporte, Delplanque, Kerbage, Rubod, Cosson, and Giraudet), Lille University Hospital, Lille, France
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Chaccour C, Giannini A, Golia D'Augè T, Ayed A, Allahqoli L, Alkatout I, Laganà AS, Chiantera V, D'Oria O, Sleiman Z. Hysterectomy Using Vaginal Natural Orifice Transluminal Endoscopic Surgery Compared with Classic Laparoscopic Hysterectomy: A New Advantageous Approach? A Systematic Review on Surgical Outcomes. Gynecol Obstet Invest 2023; 88:187-196. [PMID: 37231836 DOI: 10.1159/000530797] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/18/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Minimally invasive surgery aims to reduce surgical trauma and post-operative morbidity. Natural orifice transluminal endoscopic surgery is a safe and valid surgical option for hysterectomy. The present systematic review aims to compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (vNOTES) with laparoscopic hysterectomy in terms of efficacy, surgical outcomes, complications, and cost. MATERIALS AND METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It includes randomized controlled trials, controlled clinical trials, prospective or retrospective cohorts, case-control studies, and previous systematic reviews. Inclusion criteria are as follows: female patients undergoing hysterectomy for benign pathologies by vNOTES or laparoscopic hysterectomy. The assessed outcomes were the following: conversion rate, mean uterus weight (g), operative time (mins), hospital stay (days), peri-operative complications, post-operative complications, peri-operative blood loss (mL), blood transfusion needs, post-operative day 1 hemoglobin (Hb) change (g/dL), post-operative pain level (VAS), and cost (USD) in both techniques. RESULTS Seven studies were included. vNOTES hysterectomy was not inferior to laparoscopic hysterectomy regarding surgical outcomes, with a shorter operative time, shorter recovery time, less post-operative pain, and fewer post-operative complications. There was no significant difference in the rate of peri-operative complications and no differences in peri-operative blood loss, post-operative day 1 Hb change, and transfusions. Nevertheless, vNOTES hysterectomy was shown to be more expensive than its laparoscopic counterpart. CONCLUSIONS While the feasibility and safety of the vNOTES hysterectomy were already established, this review also underlines the noninferiority of this technique when compared to laparoscopic hysterectomy in terms of surgical outcomes. In addition, vNOTES hysterectomy was associated with faster operating time, shorter hospital stay, and better post-operative pain scores compared with laparoscopic hysterectomy.
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Affiliation(s)
- Christian Chaccour
- Obstetrics and Gynecology Department, St. Joseph University, Beirut, Lebanon
| | - Andrea Giannini
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Tullio Golia D'Augè
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy,
| | - Amal Ayed
- Farwaniah Hospital, MOH, Kuwait City, Kuwait
| | - Leila Allahqoli
- Midwifery Department, Ministry of Health and Medical Education, Tehran, Iran
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Kiel School of Gynaecological Endoscopy, Kiel, Germany
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS "Civico - Di Cristina - Benfratelli," Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Ottavia D'Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Zaki Sleiman
- Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
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Baekelandt J, Matak L, Merckx M, Housmans S, Deprest J, Tollens T. Posterior rectus fascia prolapse (PREFAP) repair: a new native tissue approach to pelvic organ prolapse via vaginal natural orifice transluminal endoscopic surgery. Arch Gynecol Obstet 2023; 307:2041-2045. [PMID: 37042995 DOI: 10.1007/s00404-023-07021-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/21/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Pelvic organ prolapse (POP) is a common condition in women. During lifetime, up to 40% of all women will develop (POP). MATERIALS AND METHODS Between June and December 2021, five patients were successfully treated via vNOTES Posterior Rectus Fascia Prolapse ( PREFAP) repair. No intra-operative complications or conversions occurred. CONCLUSION In this study we demonstrated a new technique for prolapse repair, harvesting the autologous posterior rectus fascia sheath via vaginal natural orifice transluminal endoscopic surgery (vNOTES) as an alternative for a synthetic mesh.
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Affiliation(s)
- Jan Baekelandt
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium.
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium.
| | - Luka Matak
- Department of Obstetrics and Gynecology, General Hospital Zadar, Zadar, Croatia
| | - Micaelle Merckx
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
| | - Susanne Housmans
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
| | - Jan Deprest
- Department of Development and Regeneration, Faculty of Medicine, Group Biomedical Sciences, KU Leuven, Louvain, Belgium
| | - Tim Tollens
- Department of Surgery, Imelda Hospital, Bonheiden, Belgium
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Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8246761. [PMID: 35978643 PMCID: PMC9377874 DOI: 10.1155/2022/8246761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/31/2022] [Accepted: 06/30/2022] [Indexed: 11/18/2022]
Abstract
Objective To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (VNOTES) versus transumbilical laparoscopic single-site surgery (LESS) as a minimal invasive technique. Materials and Method. The women undergoing hysterectomy for benign diseases by VNOTES and LESS from January 2020 to June 2021 in a tertiary hospital in Shanghai were retrospectively analyzed. Results 361 women were included in our study, with 228 in the VNOTES groups, 129 in the LESS groups, and 4 conversions from VNOTES to LESS technique. The length of a VNOTES hysterectomy was shorter than that of LESS (80.76 min versus 112.09 min; MD -31.34 min; 95% CI -40.24 to -22.43 min; P < 0.001). VNOTES hysterectomy has a quicker gas passage by the anus (18.80 versus 36.49 hours, MD -17.68 hours, 95% CI -20.23 to -15.14 hours, P < 0.001) and associated with a shorter length of hospital stay (2.31 versus 3.77 days, MD -1.46 days, 95% CI -1.75 to -1.17 days, P < 0.001), while with no increase in blood loss during the operation (median 50 versus 50 ml, P = 0.25). Besides, the VAS pain score in the 24th hour after the operation was lower (median 0 versus 0.5, P < 0.001) in the VNOTES group. Four unique phases of the learning curve were identified using cumulative analysis: the mean operation time of phase I was 82.81 ± 31.45 min (the initial learning curve of 43 cases), phase II was 72.48 ± 23.66 min (the acquisition of command of 91 cases), phase III was 103.77 ± 45.69 min (the further learning of 26 cases), and phase IV was 73.18 ± 26.89 min (postlearning in 68 cases). Conclusions VNOTES is noninferior to LESS as a new minimal invasive procedure for hysterectomy, which also allows patients a faster recovery from surgery and to suffer less pain, and its efficiency and feasibility in large uterine need further exploring.
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Applications of vaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:220-226. [PMID: 35895964 DOI: 10.1097/gco.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Natural orifice transluminal endoscopic surgery (NOTES) is an emerging approach used across surgical disciplines. This review seeks to assess the growing body of literature on experiences and outcomes using vaginal NOTES (vNOTES) in gynecologic surgery. RECENT FINDINGS Many limitations of vaginal surgery including lack of descensus or restricted vaginal space can be overcome with vNOTES whereas avoiding risks of abdominal incisions in traditional laparoscopy. vNOTES may have superior outcomes in pain, length of stay, and satisfaction for multiple gynecologic indications however additional data is needed to assess cost-effectiveness and long-term outcomes. Surgeons implementing this technique should have adequate experience with both traditional vaginal and laparoscopic approaches. The current body of high-quality studies is heavily influenced by single site, single surgeon studies and as such may not be fully applicable to all practices incorporating this novel technique, and adequate training should precede implementation of Vnotes. SUMMARY Vaginal surgery is considered the least invasive approach, however, may not be appropriate in all cases. vNOTES presents a novel approach that combines the access and visualization afforded by endoscopy whereas avoiding the risks associated with transabdominal entry and can be considered as a feasible option in gynecologic surgery.
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Hurni Y, Romito F, Huber DE. Is transvaginal natural orifice transluminal endoscopic surgery (vNOTES) indicated in patients with previous extensive pelvic surgeries? A case report. Case Rep Womens Health 2022; 34:e00397. [PMID: 35198415 PMCID: PMC8851094 DOI: 10.1016/j.crwh.2022.e00397] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022] Open
Abstract
Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) has been increasingly applied to perform multiple gynecologic procedures. However, evidence is lacking on whether this surgical approach is feasible for patients with prior extensive abdominopelvic surgeries. We report a case of prophylactic bilateral salpingo-oophorectomy (BSO) performed in a 51-year-old patient with previous laparotomic radical hysterectomy and pelvic lymphadenectomy for cervical cancer. The patient underwent rectovaginal examination and evaluation of the transvaginal sonographic sliding sign as preoperative screening to exclude the obliteration of the pouch of Douglas. The abdominal cavity was accessed by cautious endoscopic access to the pouch of Douglas. The BSO was realized in accordance with risk-reducing surgery guidelines. No intraoperative or postoperative complications were observed. We suggest that selecting patients carefully prior to operation and adapting intraoperative techniques could be a safe method for conducting vNOTES interventions in patients with extensive abdominopelvic adhesions. vNOTES has been increasingly applied to perform multiple gynecologic procedures. There is a lack of evidence for its feasibility for patients who have previously had extensive surgery. Careful preoperative evaluations and intraoperative adaptations are needed. Extensive pelvic adhesiolysis by vNOTES appears feasible. We report a vNOTES intervention in a patient with previous extensive surgery.
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Affiliation(s)
- Yannick Hurni
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
- Corresponding author at: Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland.
| | - Fabien Romito
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
| | - Daniela Emanuela Huber
- Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospitals, Boulevard de la Cluse 30, 1205 Geneva, (Switzerland)
- Department of Gynecology and Obstetrics, Valais Hospital, Av. du Grand-Champsec 80, 1951 Sion, Switzerland
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Maryns AS, Makar A, Hamerlynck T, De Vree B, Tummers P, Tjalma WAA. Survey: acceptability of opportunistic bilateral salpingectomy in Flanders. Facts Views Vis Obgyn 2021; 13:241-249. [PMID: 34555878 PMCID: PMC8823277 DOI: 10.52054/fvvo.13.3.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The VVOG (Flemish Society of Obstetrics and Gynaecology) published a consensus statement promoting opportunistic bilateral salpingectomy (OBS). Objectives The aim of the study was to obtain insight into the current opinion and general practice of Flemish gynaecologists to counsel and perform OBS. Materials and Methods A questionnaire was distributed to Flemish gynaecologists three months after publication of the consensus statement. Main outcome measures The drawbacks and incentives to counsel and perform OBS were questioned. Results Complete response rate was obtained from 99 gynaecologists (17%) and 37 trainees (19%). The majority of respondents (77%) always counselled for OBS in patients scheduled for hysterectomy without oophorectomy. Eighteen per cent counselled only above a certain age cut off and/or if patient was already menopausal. The most important incentive to counsel in cases of hysterectomy by the abdominal approach and vaginal hysterectomy (VH) was the opportunity to prevent ovarian cancer. The yet-undetermined risk of premature ovarian failure was mentioned as the most important barrier in counselling women for OBS in those undergoing hysterectomy by the abdominal approach. For VH, the respondents saw the risk of complications and increased surgical time as the most important barriers. Sixty-one percent of gynaecologists preferred to perform bilateral salpingectomy as sterilisation method. Conclusions Our study suggests that the concept of OBS is already well known in Flanders. There is a positive attitude towards the routine implementation of OBS, although some barriers and doubts about an age cut-off still exist in practice.
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Nulens K, Kempenaers R, Baekelandt J. Hysterectomy via vaginal Natural Orifice Transluminal Endoscopic Surgery in virgin patients: a first feasibility study. J OBSTET GYNAECOL 2021; 42:116-121. [PMID: 33892619 DOI: 10.1080/01443615.2020.1867972] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a minimally invasive, scar-free technique that uses a vaginal colpotomy to access the peritoneal cavity. Hysterectomy via vNOTES has shown to be technically feasible and safe, with shorter hospital stay and lower postoperative pain scores. Moreover, vNOTES adds the advantages of endoscopy to those of vaginal surgery and thereby broadens the indications of a conventional vaginal hysterectomy. Virginity has been contraindicated for vNOTES so far, as vaginal accessibility can be severely reduced in virgin women. Therefore, cases of vNOTES hysterectomy in virgin patients have never been reported in the literature. The objective of this study is to assess the technical feasibility and safety of hysterectomy in virgin women. We performed a retrospective analysis of patient files of all vNOTES hysterectomies performed on virgin women in our centre (Imelda Hospital, Bonheiden, Belgium) from July 2016 until June 2020 (N = 9). Despite limited vaginal accessibility, vNOTES hysterectomy was successfully performed in all nine patients, without conversion to laparoscopy or laparotomy and without clinically relevant complications. In this first IDEAL stage 1 study, vaginal NOTES hysterectomy appears to be technically feasible and safe in virgin women.Impact statementWhat is already known on this subject? Vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is an emerging, minimally invasive technique that offers a safe alternative to laparoscopy and open surgery. Besides better cosmetics (scar-free technique), advantages of vNOTES hysterectomy include shorter hospital stay and less postoperative pain compared to laparoscopic hysterectomy. Moreover, vNOTES adds the benefits of endoscopy (visualisation of anatomy) to conventional vaginal hysterectomy. Virginity has been contraindicated for vNOTES so far, because the absence of uterine descent and narrow vagina in virgins is thought to complicate the vaginal approach. Therefore, vNOTES hysterectomy has never been reported in virgin patients.What do the results of this study add? In this study, we are the first to report the feasibility of performing a vNOTES hysterectomy in virgin patients. The results show that, in experienced hands, indications for vNOTES can be broadened and include virgin women.What are the implications of these findings for clinical practice and/or further research? This first report of vNOTES hysterectomy in virgin patients is only a small but important step in the evaluation of safety and efficacy of this emerging technique. Further research is needed to assess reproducibility of the findings and to carefully determine indications and contraindications of vNOTES.
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Affiliation(s)
- Katrien Nulens
- Department of Gynaecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium
| | - Ralph Kempenaers
- Department of Gynaecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium
| | - Jan Baekelandt
- Department of Gynaecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium
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Kim MS, Noh JJ, Kim TJ. Hysterectomy and Adnexal Procedures by Vaginal Natural Orifice Transluminal Endoscopic Surgery (VNH): Initial Findings From a Korean Surgeon. Front Med (Lausanne) 2021; 7:583147. [PMID: 33693007 PMCID: PMC7937714 DOI: 10.3389/fmed.2020.583147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/26/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate feasibility and safety of hysterectomy and adnexal procedures by vaginal natural orifice transluminal endoscopic surgery (vNOTES). Study Design: This is a prospective observational study at a tertiary center and teaching University hospital. We enrolled prospectively 34 patients with benign diseases sequentially. Results: We measured baseline characteristics, surgical data, and pain score (VAS) after surgery. We surveyed before/after surgery. The time of port installation and each stage of surgery was measured. The learning curve was assessed through the graph according to the number of operations using linear and logarithmic regression curve estimation. The complications of surgery were investigated. The median age of the patients was 47.5 years (38–73). Median BMI was 22.4 (18.2–30.0). 20 cases of leiomyoma, four cases of adenomyosis, three cases of uterine prolapse, four cases of endometrial hyperplasia, and three cases of CIN were diagnosed. The median uterine weight was 180.0 g. The median port-installation time was 15.0 min (range, 4–35 min) and median total operation time was 85.5 min (range 43.0–132.0). Complications occurred in three patients. Two cases of bladder injury happened during vesicovaginal space dissection before the installation of the Wound Retractor (WR). One patient underwent transumbilical single-port surgery because of late-onset postoperative bleeding on the 13th postoperative day. The mean postoperative VAS scores were 3.36 immediately after surgery and 3.06, 2.79, and 2.45 at 6, 12, and 24 h after surgery, respectively. In continuous variable analysis, we detected a correlation between port-installation time and postoperative VAS ≥4 (pain score as need for medication). Based on a learning curve, port-installation time and total operation time appeared to reach the proficiency level by the 10th case. Conclusions: Although there were three complications, vNOTES offers advantages to patients and surgeons. More surgical techniques will be developed in vNOTES.
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Affiliation(s)
- Myeong-Seon Kim
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Joseph J Noh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Nulens K, Van Genechten I, Baekelandt J. Repeat Vaginal Natural Orifice Transluminal Endoscopic Surgery: A First Feasibility Study. Gynecol Obstet Invest 2021; 86:117-122. [PMID: 33556956 DOI: 10.1159/000513403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/26/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is an emerging minimally invasive technique in benign gynaecologic surgery whereby surgical access to the peritoneal cavity is achieved through natural orifices, namely through a vaginal colpotomy. Experience in repeat vNOTES cases is limited and so far, repeat vNOTES cases have not been described in the literature. The purpose of this study was to demonstrate the feasibility of vNOTES hysterectomy in women with a history of previous vNOTES adnexal surgery. DESIGN We performed a retrospective cohort study of the first 11 repeat vNOTES cases in our centre. All vNOTES procedures, primary adnexal surgery as well as repeat vNOTES hysterectomy, were performed by one surgeon (J.B.). Materials, Setting, Methods: Between March 2016 and May 2020, 11 patients underwent a vNOTES hysterectomy after prior vNOTES adnexectomy or cystectomy in Imelda Hospital, Bonheiden, Belgium. Relevant patient characteristics and outcome data were collected after written informed consent. RESULTS Median age was 49 years (range 44-65) at the moment of the first vNOTES procedure. Two patients had one or more caesarean sections in history, and 2 women were nulliparous. Median interval between primary and repeat vNOTES procedure was 15 months (range 0.8-37 months). All patients underwent a vaginally assisted NOTES hysterectomy (VANH) as repeat vNOTES procedure. Performing a colpotomy and entering the peritoneal cavity after prior vNOTES was technically feasible in all cases. All VANHs were successfully performed. There were 3 minor complications after repeat vNOTES, of which one was anaesthesia-related. The 2 complications associated with the surgical procedure were both cystitis. In one of these 2 patients, there were high post-void residues, which were easily managed by bladder training. There were no conversions to laparoscopy or laparotomy, neither serious nor life-threatening complications. No ureteric, bladder, or intestinal injuries have occurred. LIMITATIONS The retrospective design and small sample size are the main limitations of this study. Moreover, the follow-up period of the most recently operated patients was too short to draw conclusions on long-term outcomes, including sexual function. CONCLUSIONS In all patients in this case series, vNOTES hysterectomy after prior vNOTES adnexal surgery was successfully performed. Large-scale prospective trials with long-term follow-up are needed to evaluate the safety and feasibility of multiple consecutive vNOTES procedures in 1 patient.
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Affiliation(s)
- Katrien Nulens
- Department of Gynecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium,
| | - Ilse Van Genechten
- Department of Gynecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium
| | - Jan Baekelandt
- Department of Gynecology and Obstetrics, Imelda Hospital, Bonheiden, Belgium
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Benign Gynaecological procedures by vaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES): Complication data from a series of 1000 patients. Eur J Obstet Gynecol Reprod Biol 2021; 256:221-224. [DOI: 10.1016/j.ejogrb.2020.10.059] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/21/2022]
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vNOTES Hysterectomy for Large Uteri: A Retrospective Cohort Study of 114 Patients. J Minim Invasive Gynecol 2020; 28:1351-1356. [PMID: 33065258 DOI: 10.1016/j.jmig.2020.10.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVE To evaluate the outcome of hysterectomy through vaginal natural orifice transluminal endoscopic surgery (vNOTES) in cases with a large uterus. DESIGN A retrospective cohort study. SETTING Belgian teaching hospital. PATIENTS Women who underwent a vNOTES hysterectomy from March 2015 to March 2020 for benign gynecologic disease with a uterine weight of 280 g or more on pathologic examination (N = 114). INTERVENTIONS All women underwent vaginally assisted NOTES hysterectomy. We performed a retrospective analysis of baseline patient characteristics and clinical outcomes. MEASUREMENTS AND MAIN RESULTS The mean age was 50 ± 3.5 years. Twenty-two (19%) patients were obese (body mass index ≥30 kg/m2), and 4 (3.5%) were morbidly obese (body mass index ≥40 kg/m2). Thirty-five (31%) patients were nulliparous, and 15 (13%) women had 1 or more cesarean sections in their medical history. Uterine weight varied from 281 g to 3361 g, with a mean weight of 559 ± 425 g. Mean surgical time was 63 ± 34 minutes. Surgical time was positively associated with uterine size. There were 4 complications: 3 bleeding complications in the first 24 hours after surgery and 1 minor late complication. Conversion to laparotomy for specimen extraction was performed in 1 case (conversion rate 0.9%). There were no conversions to laparoscopy. No ureteric, bladder, or intestinal injuries occurred in this case series, and there were neither life-threatening complications nor intensive care unit admissions. CONCLUSION The vNOTES technique can offer a safe and effective alternative to laparoscopy or laparotomy in cases with a large to very large uterus, even if the patient has a history of cesarean section, obesity, or nulliparity. In 99% of all women in this study, hysterectomy was successfully performed through vNOTES without conversion. By making use of the advantages of endoscopic surgery, vNOTES might broaden the indications of vaginal hysterectomy. Randomized controlled trials are needed to evaluate whether vaginally assisted NOTES hysterectomy is superior to laparoscopic or abdominal hysterectomy in large uteri cases.
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Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BWJ, Bosteels JJA. Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day‐care procedure: a randomised controlled trial. BJOG 2018; 126:105-113. [DOI: 10.1111/1471-0528.15504] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 12/31/2022]
Affiliation(s)
- JF Baekelandt
- Department of Obstetrics and Gynaecology Imelda Hospital Bonheiden Belgium
| | - PA De Mulder
- Department of Anaesthesiology Imelda Hospital Bonheiden Belgium
| | - I Le Roy
- Department of Anaesthesiology Imelda Hospital Bonheiden Belgium
| | - C Mathieu
- Clinical and Experimental Endocrinology KU Leuven – University of Leuven Leuven Belgium
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L‐BioStat) KU Leuven – University of Leuven Leuven Belgium
| | - P Enzlin
- Interfaculty Institute for Family and Sexuality Studies KU Leuven – University of Leuven Leuven Belgium
| | - S Weyers
- Universitaire Vrouwenkliniek University of Ghent Ghent Belgium
| | - BWJ Mol
- Department of Obstetrics and Gynaecology Monash University Clayton Vic. Australia
| | - JJA Bosteels
- Department of Obstetrics and Gynaecology Imelda Hospital Bonheiden Belgium
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Kaya C, Alay İ, Ekin M, Yaşar L. Hysterectomy by vaginal-assisted natural orifice transluminal endoscopic surgery: Initial experience with twelve cases. J Turk Ger Gynecol Assoc 2018; 19:34-38. [PMID: 29503260 PMCID: PMC5838776 DOI: 10.4274/jtgga.2017.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: To declare our initial experience on hysterectomy cases performed using vaginally-assisted natural orifice transluminal endoscopic surgery. Material and Methods: The study was conducted with data from 12 patients in our department who were recommended for hysterectomies for various indications between January 2017 and May 2017. The following data were collected retrospectively: age, body mass index (BMI), parity, previous abdominal or pelvic surgery, total operating time, preoperative hemoglobin (Hb), postoperative Hb, peri-operative complications and Visual Analogue Scale scores for evaluating postoperative pain. All patients were laid in the dorsal lithotomy position under general anesthesia. A cervical circumcision, as well as anterior and posterior colpotomy were performed. A self-constructed glove port was then inserted through the anterior and posterior colpotomy openings into the abdominal cavity. After pneumoperitoneum was achieved, a 10-mm rigid zero-degree telescope, disposable conventional laparoscopic grasping forceps, and a tissue sealer were used as standard equipment. After exploration of the abdominal cavity, all uterine vessels and ligaments were sealed and transected using the tissue sealer. After removing the uterus, the vaginal opening was closed using a Vicryl 1-0 suture. Results: The following are the mean values for each variable: patients’ age: 55.75±9.8 years (range, 43-72 years), BMI: 29.4±5.4 kg/m2 (range, 21-42 kg/m2), operation duration: 66.8±25.3 min (range, 42-120 min), decrease in Hb: 1.5±1 (0-4) gr/dL, and hospital stay: 2.1±0.3 (2-3) days. There were no vaginal wound infections or dehiscence, and no patients reported pain during postoperative pelvic examinations. Conclusion: Although these findings are from our initial experience, we can affirm the feasibility of this technique.
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Affiliation(s)
- Cihan Kaya
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İsmail Alay
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Murat Ekin
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Levent Yaşar
- Clinic of Obstetrics and Gynecology, University of Health Sciences, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Baekelandt JF, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BWJ, Bosteels JJA. Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) adnexectomy for benign pathology compared with laparoscopic excision (NOTABLE): a protocol for a randomised controlled trial. BMJ Open 2018; 8:e018059. [PMID: 29326183 PMCID: PMC5780723 DOI: 10.1136/bmjopen-2017-018059] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Natural orifice transluminal endoscopic surgery (NOTES) uses natural orifices to access the cavities of the human body to perform surgical interventions. NOTES limits the magnitude of surgical trauma and potentially reduces postoperative pain. Our group published a protocol on a randomised study comparing transvaginal NOTES (vNOTES) versus laparoscopy for hysterectomy (HALON). We simultaneously designed a similar randomised controlled trial (RCT) comparing vNOTES with laparoscopy for adnexectomy. To the best of our knowledge, this is the first RCT comparing vNOTES with laparoscopy for adnexal surgery. METHODS AND ANALYSIS The methodology of the Notes Adnexectomy for Benign Indication versus Laparoscopic Excision (NOTABLE) study is similar to that of the HALON trial. Women aged 18-70 years with an indication for benign adnexal surgery will be eligible. We will use stratification according to adnexal size. Entrants will be randomised to the laparoscopic treatment (control) or vNOTES (intervention). Participants will be evaluated on days 0-7 and at 3 and 6 months. The primary outcome will be the proportion of women successfully treated by removing an adnexa by the allocated technique without conversion. We will collect the following data (secondary outcomes): proportion of women hospitalised on the day of surgery, postoperative pain scores measured two times per day from day 1 to 7, total dosage of pain killers used from day 1 to 7, hospital readmission during the first 6 weeks, dyspareunia and sexual well-being at baseline, 3 and 6 months using a validated questionnaire (Short Sexual Functioning Scale), health-related quality of life at baseline, 3 and 6 months after surgery using a validated questionnaire (EQ-5D-3L), duration of surgical intervention, infection or other surgical complications and direct costs up to 6 weeks following surgery. For the primary outcome measure, a one-sided 95% CI of the difference in the proportions of women with a successful removal of the uterus by the randomised technique will be estimated. Non-inferiority will be concluded when 15% lies above the upper limit of this 95% CI. ETHICS AND DISSEMINATION The study was approved on 1 December 2015 by the EthicsCommitteeof the Imelda Hospital (registration no: 689), Bonheiden, Belgium. We aim to present the final results of the NOTABLE trial in peer-reviewed journals and at scientific meetings within 4 years after the start of the recruitment. TRIAL REGISTRATION NUMBER NCT02630329.
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Affiliation(s)
| | | | - Ilse Le Roy
- Department of Anaesthesiology, Imelda Hospital, Bonheiden, Belgium
| | - Chantal Mathieu
- Department of Clinical and Experimental Medicine, KU Leuven-University of Leuven, Leuven, Belgium
- Division of Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism and Ageing, KU Leuven-University of Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven-University of Leuven, Leuven, Belgium
| | - Paul Enzlin
- Department of Neurosciences, Interfaculty Institute for Family and Sexuality Studies, KU Leuven-University of Leuven, Leuven, Belgium
| | - Steven Weyers
- Universitaire Vrouwenkliniek, Ghent University Hospital, Ghent, Belgium
| | - Ben W J Mol
- The Robinson Institute, The University of Adelaide, Adelaide, South Australia, Australia
- School of Paediatrics & Reproductive Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jan J A Bosteels
- Department of Gynaecology, Imelda Hospital, Bonheiden, Belgium
- Academic Centre for General Practice, KU Leuven-University of Leuven, Leuven, Belgium
- Universitaire Vrouwenkliniek, Ghent University Hospital, Ghent, Belgium
- CEBAM, The Centre for Evidence-based Medicine, Cochrane Belgium, KU Leuven-University of Leuven, Leuven, Belgium
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Ding DC, Chu TY, Hong MK. Hysterectomy and ovarian cystectomy using natural orifice transluminal endoscopic surgery: An initial experience at Tzu Chi General Hospital. Tzu Chi Med J 2017; 29:208-212. [PMID: 29296049 PMCID: PMC5740693 DOI: 10.4103/tcmj.tcmj_127_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/24/2017] [Accepted: 05/09/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The objective of this study is to report our initial experience with patients undergoing transvaginal natural orifice transluminal endoscopic surgery (NOTES). MATERIALS AND METHODS From September 2016 to December 2016, patients who were not virgins and did not have pelvic inflammation or obliteration of the cul-de-sac who underwent NOTES hysterectomy or ovarian cystectomy (OC) were included in the study. RESULTS Transvaginal NOTES was performed smoothly in six patients, two patients (mean age 35 years, mean body mass index [BMI] 25) received an OC and four patients (mean age 49 years, mean BMI 27) underwent a hysterectomy. One patient with a hysterectomy received concurrent adhesiolysis. The mean surgical times were 74 and 75 min and blood loss was 50 and 87.5 ml in the OC and hysterectomy groups, respectively. One patient with a hysterectomy had a postoperative fever with 38°C last for 2 days. Pain scores were 0 at 48 h postoperatively in both groups. CONCLUSION Transvaginal NOTES is a feasible and safe technique for hysterectomy and OC in our patients and those in previous reports. This procedure was minimally invasive with no scars on the abdomen as well as little pain.
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Affiliation(s)
- Dah-Ching Ding
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Tang-Yuan Chu
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
| | - Mun-Kun Hong
- Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Baekelandt J, De Mulder PA, Le Roy I, Mathieu C, Laenen A, Enzlin P, Weyers S, Mol BW, Bosteels JJ. Postoperative outcomes and quality of life following hysterectomy by natural orifice transluminal endoscopic surgery (NOTES) compared to laparoscopy in women with a non-prolapsed uterus and benign gynaecological disease: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2017; 208:6-15. [DOI: 10.1016/j.ejogrb.2016.10.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 08/27/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
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